Women spend 20% more per year on out-of-pocket health costs, says report

Women of all ages pay a total of $15.4 billion more than men on annual out-of-pocket medical expenses, according to a new report from Deloitte. In 2021, that meant that women paid about 20% more than men — only 2% of which could be accounted for by maternity care.

The fact that the way benefits are currently designed “puts a disproportionate cost on women, above and beyond maternity, was the thing that really surprised us,” said Kulleni Gebreyes, a physician who runs Deloitte’s health care practice and also serves as the company’s U.S. chief health equity officer.

The “pink tax,” in which products marketed to women cost more than similar products aimed at men, is a familiar phenomenon to many. But that typically applies to items like pink razors and floral soaps — not annual check-ups and cancer screenings. The Affordable Care Act also dictates that insurers charge men and women the same premium costs. But the new analysis found that despite seeking more health care treatments than men, ​​women have lower actuarial values, meaning that insurance covers less of their health claims than it does for men.

To perform this analysis, researchers at Deloitte looked at a sample of more than 16 million people aged 19-64 with employer-sponsored health insurance. They analyzed the costs for payers’ total medical services from 2017-2022 as if each received the average single-person medical benefit design. Due to the sex and gender data that was available, analysts were constricted to a binary of women and men, which they acknowledged does not represent gender-diverse people.

They found that women spend more money on services far beyond maternity and childbirth care. Radiology, laboratory, mental health, emergency care, office visits, and physical or occupational therapy were key areas where women paid more than men.

These categories “aren’t particularly eye-opening, though, because they kind of capture everything,” said Jessica Cohen, a health economist and professor at the Harvard T. H. Chan School of Public Health who was not involved in the analysis. Pharmacy costs were not included in the analysis, but otherwise, it was difficult to think of major areas of care that wouldn’t fall under the identified categories, she said.

Men are twice as likely as women to wait more than two years between visits to a health care professional, according to the report. Yet when they do go, they need fewer services.

The report identified a few reasons why women may utilize health care more than men, including recommendations for annual check-ups at earlier ages, the regular frequency of gynecological exams, the effects of menopausal transitions, and more. But it was harder to pin down a reason for the huge gap in actuarial values.

One potential cause could be that, while insurers cover basic, preventative care that people receive, they may not cover the expensive follow-up services. For example, if a woman receives a standard mammogram, insurance would cover it. But if they need follow-up imaging for an abnormal result, the copay charges begin to stack up.

Another possible explanation could be that women may have have worse insurance plans with higher deductibles or copays — which is what Cohen suspects. That difference could be attributed to gender disparities in the types of industries that women and men work in, or because women are more likely to be part-time workers.

“What we’re really challenging is, when you’re designing benefits, the difference between equality — paying the same premium — and equity — having benefit coverage that meets your needs,” Gebreyes said.

The report proposed that insurers and employers who provide insurance run similar analysis on their own members or employees in order to figure out whether needed services are being equitably covered. Deloitte’s analysts calculated that adjusting benefit design to change cost-sharing for certain services would cost employers less than $12 per year per employee. Still, the incentive for insurers to make the needed changes may differ depending on one’s outlook.

“If we’re just talking bottom line and the cold, cold heart type of view, the only incentive is if they think that these higher out-of-pocket costs are leading people to get less care,” Cohen said. When people put off needed care due to high costs, their health gets worse, leading to more urgent and more expensive needs farther down the line.

Gebreyes says that employers need to push for change: “It’s just the right thing to do … If you believe in the humanness of every single one of your employees, this is a workforce issue.”